Management of pulmonary nodules across Latin America: A real-world observational study.

Abstract

8030 Background: Lung cancer is the leading cause of cancer-related mortality globally, with lung cancer accounting for 6.8% of all cancer cases in Latin America and the Caribbean. Despite the availability of guidelines, lung cancer early detection and the management of pulmonary nodules across the region are inconsistent, often hindered by limited resources and fragmented health systems. This study aimed to characterize the diagnostic and treatment journey of pulmonary nodules in patients with lung cancer across Latin America. Methods: This was a non-interventional observational study that captured retrospective (March 2019 to July 2021) and prospective (July 2021 to March 2023) data across 16 health institutions in Latin America. Participants were followed for at least two years or until treatment initiation or withdrawal. Data were collected from patients’ medical records. Patient characteristics and physicians' involvement were summarised descriptively. Median time estimates of receiving diagnostic procedure or examination from nodule identification and estimates on median time of treatment decision from lung cancer diagnosis were analysed descriptively using the Kaplan-Meier (KM) method. Results: Among a total of 546 participants (215 prospective; 331 retrospective), 82 were diagnosed with lung cancer during the study period, most commonly with Stage I lung cancer (5.9%). The majority of referrals to dedicated nodule clinics were made by pulmonologists (44.1%) and prompted by incidentally detected pulmonary nodules (83.9%), which were typically solid and ranged from 8mm to 3cm in size (79.5%). The median time to receiving a diagnostic procedure from nodule identification was 10.83 (prospective) and 12.47 (retrospective) months, while the median time to treatment decision post-diagnosis was 1.20 months across both cohorts. Multidisciplinary teams were involved in only 0.3% of diagnostic procedures, but were involved in at least 40% of treatment decisions across different follow-up visits. Conclusions: This study reveals substantial delays in diagnostic procedures and limited multidisciplinary team involvement during early patient evaluation phases in Latin America. Compared with international studies, the study population experienced considerably longer delays in receiving diagnostic procedures. These findings underscore the need for structured referral pathways and broader implementation of critical tools across the region. In addition, adherence to established guidelines is critical to improve early detection and treatment outcomes of lung cancer patients.